Migraine, Tension Headache and Stress

October 24, 2009 by dean · Leave a Comment 

Managing stress helps headache and migraine

Managing stress helps headache and migraine

Why is it that when stress and migraine and tension headache are discussed studies all sorts of unproven mechanisms are discussed at length – despite all of the research and billions of dollars there is no proven causal mechanism – ‘it may be this …. or ‘it may be that‘ etc.

Muscle tension is evident in the necks of ‘tension headache‘ sufferers and migraineurs – it is tensed, shortened musculature acting on joint stiffness which leads to head pain.1

Research has shown that stress management approaches, including Relaxation Therapy and cognitive behavioural therapy consistently improve migraine 2 – if you are less stressed then stiff spinal segments sit quietly without any significant movement expected of them. Biofeedback is also helpful in managing migraine 2 for the same reason.

It can be very difficult to manage stress in our lives (for a whole lot of reasons including heart disease, depression, and other mental health disorders) and whilst is is important to take measures to do this, from a headache and migraine point of view, identifying and eliminating relevant neck disorders is crucial.

Cheers

Dean

(1. Bakal DA, Kaganov JA. Muscle Contraction and Migraine Headache: Psychophysiologic Comparison. Headache 1977;17(5):208215

2. Rains JC, Penzien DB, McCrory DC, Gray RN. Behavioral headache treatment: History, review of the empirical literature, and methodological critique. Headache. 2005;45(Suppl. 2): S92-S109.)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Exercise and Migraine

October 20, 2009 by dean · Leave a Comment 

Exercise encourages serotonin production

Exercise encourages serotonin production

In a recent study 30 female migraineurs undertook an aerobic exercise program.

Measures of pain and psychological assessment (including body image, depression and quality if life) were assessed before and after completion of the 6 week exercise and exercise program.

The program led to a significant reduction migraine pain intensity. This is not surprising as exercise encourages serotonin production which desensitises the brainstem. Interestingly there was also an improvement in the depression related symptoms (I would be happier to if my migraine was less severe!), but the psychological factors were no different (good to see my experience confirmed i.e. migraine sufferers are psychologically normal!)

Sensitisation of the brainstem in my experience occurs because of a neck disorder and whilst increased serotonin is likely to improve symptoms the cause of the senstisation is still there. It is important that this (the neck) be confirmed and addressed – but start (and keep) exercising as well!

Cheers

Dean

(Dittrich SM, Guünther V, Franz G, Burtscher M, Holzner B, Kopp M. Clin J Sport Med. 2008;18:363-365 Aerobic exercise with relaxation: Influence on pain and psychological well-being in female patients. Clin J Sport Med. 2008;18:363-365)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Sumatriptan Effective in a Range of Headache and Migraine

July 12, 2009 by dean · Leave a Comment 

One hundred and fourteen patients were diagnosed as migraine, 76 as tension-type headache, and 42 were not able to be classified according to the International Headache Society’s diagnostic criteria.

Ninety six per cent of migraineurs responded to sumatriptan, whilst it was effective in 97% and 95% of tension headache sufferers and unclassifiable headaches respectively .

This response clearly demonstrates that there is a common underlying mechanism for a range of headache and migraine conditions – and the recent research suggests that it is a sensitised brainstem – and the action of sumatriptan? It desensitises the brainstem.

A thorough examination of the upper neck will either confirm of negate cervical disorders as the sensitising source.

Cheers

Dean

(Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes – prolonged effects from a single injection. Pain 2006; 122:126-9) 2009

Anderson CD, Franks RA. Migraine and tension headache: is there a physiological difference? Headache 1981; 21:63-71

Cady RK, Gutterman D, Saires JA, Beach ME. Responsiveness of non-IHS migraine and tesnion-type headache to sumatrptan. Cephalalgia 1997;17:588-90

Cady R, Schreiber C, Farmer K, Sheftell F. Primary headaches: a convergence hypothesis. Headache 2002; 42:204-16

Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-198

Featherstone HJ. Migraine and muscle contraction headaches: a continuum. Headache 1985; 25:194-8

Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, 2nd edn. Cephalalgia 2004; 24(suppl.1):1-151

Hoskin KL, Kaube H, Goadsby PJ. Sumatriptan can inhibit trigeminal afferents by an exclusively neural mechanism. Brain1996; 119:1419-28

Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819

Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453

Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238

Marcus D, Scharff L, Mercer S, Turk D. Musculoskeletal abnormalities in chronic headache: a controlled comparison of headache diagnostic groups. Headache 1999; 39:21-27

Marcus DA. Migraine and tension-type headaches: the questionable validity of current classification systems. Clin J Pain 1992; 8:28-36

Mercer S, Marcus DA, Nash J. Cervical musculoskeletal disorders in migraine and tension-type headache. Paper presented at the 68th Annual Meeting of the American Physical Therapy Association; 1993; Cincinatti, Ohio

Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38

Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312

Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585

Nelson CF. The tension headache, migraine headache continuum: A hypothesis J Manipulative Physiol Ther 1994; 17:156-167

Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138

Sjaastad O, Fredricksen TA, Pfaffenrath V. Cervicogenic headache: diagnostic criteria. Headache 1998; 38:442-5)

Vernon H, Steiman I, Hagino C. Cervicogenic dysfunction in muscle contraction headache and migraine: A descriptive study. J Manipulative Physiol Ther 1992; 15:418-429)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Cluster Headache, Migraine and Tension Headache are related – more evidence ….

June 25, 2009 by dean · Leave a Comment 

The brainstem sits at the bottom of the brain

The brainstem sits at the bottom of the brain

Clinical correspondence in the latest Cephalalgia journal reports the presence of ‘cutaneous allodynia’ in two cluster headache patients.

What is cutaneous allodynia? Cutaneous (relating to or affecting the skin) allodynia (is a painful response to a normally non painful stimulus) so in this case there is a heightened, painful sensitivity to touch. This increased sensitivity to touch, along with other symptoms for e.g. photo-phobia (heightened sensitivity to light) and phono-phobia (heightened sensitivity to sound) is a sign of sensitisation of the brainstem.

Research shows quite clearly that the brainstems of migraineurs and tension headache sufferers are also sensitised …. and what do the ‘triptans’ do? they desensitise the brainstem and that is why they are effective in alleviating the pain in migraine, tension and cluster headache – all three headaches originate from the same condition i.e. a sensitised brainstem.

Cheers

Dean

(Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819

Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453

Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238

Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312

Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585

Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38

Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009;29:796-798

Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.

Tension Headache, Migraine and Cluster Headache

June 22, 2009 by dean · Leave a Comment 

The research clearly shows that the brainstems in tension headache sufferers and migraineurs are sensitised. One of the signs of sensitisation of the brainstem is ‘allodynia’ and therefore is present in tension headache and migraine patients.

What is ‘allodynia’? ‘Allodynia’ refers to excessive tenderness to physical pressure or touch.

Recent, interesting and exciting research has shown that cluster headache sufferers, also present with ‘allodynia’ – suggesting that those who endure cluster headache have sensitised brainstems. This, along with the fact that the ‘triptans’ are also effective in eliminating cluster headache, supports those authorities who suggest that the various types of headache and migraine originate from one condition or disorder – a sensitised brainstem.

Cheers

Dean

(Ashkenazi A, YoungWB. Dynamic mechanical (brush) allodynia in cluster headache. Headache 2004;44:1010-1012.

Katsavara Z, Giffin N, Diener HC, Kaube H. Abnormal habituation of ‘nociceptive’ blink reflex in migraine – evidence for increased excitability of trigeminal nociception. Cephalalgia 2003; 23:814-819

Katsavara Z, Lehnerdt G, Duda B, Ellrich J, Diener HC, Kaube H. Sensitization of trigeminal nociception specific for migraine but not pain of sinusitis. Neurology 2002; 59:1450-1453

Kaube H, Katasavara Z, Przywara S, Drepper J, Ellrich J, Diener HC. Acute migraine headache. Possible sensitization of neurons in the spinal trigeminal nucleus? Neurology 2002; 58:1234-1238

Milanov I, Bogdanova D. Trigemino-cervical reflex in patients with headache. Cephalalgia 2003; 23:35-38

Nardone R, Tezzon F. The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 2003; 10(3):307-312

Nardone R et al Trigemino-Cervical Reflex Abnormalities in Patients with Migraine and Cluster Headache. Headache 2008; 48(4):578-585

Riederer F, Selekler HM, Sandor PS, Wober C. Cutaneous allodynia during cluster headache attacks. Cephalalgia 2009; 29:796–798

Rozen TD, Haynes GV, Saper JR, SheftellFD. Abrupt onset and termination of cutaneous allodynia (central sensitization) during attacks of SUNCT. Headache 2005;45:153-155

Sandrini G, Cecchini AB, Milanov I, Tassorelli C, Buzzi MG, Nappi G. Electrophysiological evidence for trigeminal neuron sensitisation in patients with migraine. Neurosci Lett 2002; 317:135-138)

© 2009 & Beyond. Watson Headache Institute, All Rights Reserved.